Cough and lethargy associated with ibuprofen use
Question:
3/8/2024
I have a 50 year old who experienced dry cough and generalized feeling of lethargy/exhaustion following ingestion of ibuprofen 400-600mg on three separate occasions. Symptoms start with a cough and do not progress to shortness of breath, chest tightness. Symptoms abate after resting/sleeping and he is back to his baseline self within 12 hours. He takes Zyrtec and singular regularly. Have you seen anything like this in the literature? I came across an article, which proposed that ibuprofen has chemesthetic properties. "Ibuprofen may produce its signature throat irritation by stimulating a class of epithelial pH-sensitive receptors that mediate stinging/pricking sensations, and a subset of mechanically sensitive receptors that play a role in generating tickle and cough." I wanted to get your take on this because I am not fully convinced that this is an IgE mediated mechanism. However, if he is symptomatic with reproducible symptoms, I would recommend avoidance. My plan is to challenge to celecoxib and consider challenging to a non-propionic NSAID in the future.
Answer:
It is very unlikely that 12 hours of coughing and lethargy associated with ibuprofen use is an IgE-mediated hypersensitivity.
If the symptoms start within 2 hours of ingestion, it may be a mild form of nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease, particularly if there are any associated nasal symptoms with the coughing or similar symptoms have occurred with aspirin use in the past.
It may be worthwhile to formally confirm the ibuprofen intolerance, with the patient off cetirizine and montelukast, documenting all of the specific associated symptoms, during an office challenge.
If the ibuprofen challenge was positive, the next step would be to confirm celecoxib tolerance as you were planning.
If the ibuprofen challenge was positive, I would also continue to avoid all other non-COX-2 inhibitor specific NSAIDs.
Eric Macy, MD, MS, FAAAAI